Delaying Range of Motion Exercises After Rotator Cuff Repair
Rotator cuff tears are one of the most common shoulder injuries and become increasingly prevalent as someone ages1. Over 50% of older adults (above 60 years old) experience some degree of a rotator cuff tear1. A common treatment for rotator cuff tears is an arthroscopic rotator cuff repair surgery, but with it often comes long post-surgical rehabilitation, which is typically a period of immobilization for up to six weeks where motion exercises are delayed2. Recently, within the past decade, some surgeons have been examining rehabilitation with early range of motion instead of delayed range of motion in an effort to decrease stiffness and increase the range of motion of the rotator cuff post operation3. Given the prevalence of this injury and the burden that it brings, particularly to older adults with a long rehabilitation period, it is important to understand which rehabilitation plan would best aid in rotator cuff tear recovery2.
A recent literature review by Bakti et al. investigated which of the two rehabilitation plans is most optimal following rotator cuff surgery4. Upon an examination of the literature, Baki et al. found that patients whose rehabilitation included early motion had a greater range of motion post-recovery, but also an increased incidence of retear of their rotator cuff4. For patients whose rehabilitation included delayed motion, there was a decreased risk of retear and generally better patient outcomes, even though there was a possible risk of decreased range of motion4.
Focusing specifically on randomized controlled trials, Chen et al.’s meta-analysis also explored the efficacy of the two rehabilitation plans3. Similar to Bakti et al., this meta-analysis found that early motion during rehabilitation led to increased range of motion, but also an increased recurrence of rotator cuff tears3. Delayed range of motion, on the other hand, led to increased tendon healing rates and decreased rates of retearing, but patients had a decreased range of motion than those in the early group3. With this, Chen et al. suggest that delayed range of motion is more optimal in a rehabilitation plan since a lower range of motion is easier to deal with than a recurring rotator cuff tear3. Additionally, the researchers claim that the higher rate of tendon healing also gives delayed range of motion an advantage3.
Contrary to these results, a meta-analysis by Shen et al. found no significant difference in tendon healing between early and delayed motion5. Shen et al. analyzed randomized control trials that followed patients one year post-operation, and consistently found that after one year, the only significant difference between the two rehabilitation plans was that there was a greater range of motion recovery in patients who had the early motion exercises during rehabilitation5.
Overall, current literature seems to suggest that the general advantage of delayed range of motion is the low risk of retearing, whereas the advantage of early range of motion is the higher rate of recovery for range of motion. Research on this field is still rapidly changing as medical professionals try to understand the benefits of different rehabilitation protocols for rotator cuff repair, because current research has not yet come to a decisive conclusion about whether delaying range of motion exercises is more or less effective than early range of motion for rotator cuff rehabilitation.
References:
(1) Bartolozzi A, Andreychik D, Ahmad S. Determinants of Outcome in the Treatment
of Rotator Cuff Disease. Clinical Orthopaedics and Related Research. 1994;(308). doi:10.1097/00003086-199411000-00015.
(2) Fermont AJ, Wolterbeek N, Wessel RN, Baeyens J-P, Bie RAD. Prognostic Factors
for Successful Recovery After Arthroscopic Rotator Cuff Repair: A Systematic Literature Review. Journal of Orthopaedic & Sports Physical Therapy. 2014;44(3):153-163. doi:10.2519/jospt.2014.4832.
(3) Chen L, Peng K, Zhang D, Peng J, Xing F, Xiang Z. Rehabilitation protocol after
arthroscopic rotator cuff repair: early versus delayed motion. Int J Clin Exp Med. 2015;8(6):8329–8338. Published 2015 Jun 15.
(4) Bakti N, Antonios T, Phadke A, Singh B. Early versus delayed mobilization
following rotator cuff repair. J Clin Orthop Trauma. 2019;10(2):257–260. doi:10.1016/j.jcot.2019.01.016
(5) Shen C, Tang ZH, Hu JZ, Zou GY, Xiao RC, Yan DX. Does immobilization after
arthroscopic rotator cuff repair increase tendon healing? A systematic review and meta-analysis. Arch Orthop Trauma Surg. 2014;134(9):1279–1285. doi:10.1007/s00402-014-2028-2